International Journal of Women's Health最新文献

Genitourinary syndrome of the menopause (GSM) is a chronic, often progressive condition, characterised by symptoms relating to oestrogen deficiency including; vaginal dryness, burning, itching, dyspareunia, dysuria, urinary urgency and recurrent urinary tract infections. GSM affects up to 70% of breast cancer survivors with a tendency to particularly severe symptoms, owing to the effects of iatrogenic menopause and endocrine therapy. Patients and clinicians can be reluctant to replace oestrogen vaginally due to fear of cancer recurrence. Vaginal laser is a novel therapy, which may become a valuable nonhormonal alternative in GSM treatment. There are currently 6 published studies regarding Erbium:YAG laser treatment for GSM, 41 studies regarding CO2 laser treatment for GSM and 28 studies regarding vaginal laser treatment for GSM in breast cancer survivors. Number of participants ranges from 12 to 645. The majority of studies describe a course of 3 treatments, but some report outcomes after 5. Significant improvements were reported in vaginal dryness, burning, dyspareunia, itch, Vaginal Health Index Scores (VHIS), Quality of Life, and FSFI (Female Sexual Function Index). Most studies reported outcomes at short-term follow-up from 30 days to 12 months post-treatment. Few studies report longer-term outcomes with conflicting results. Whilst some studies suggest improvements are sustained up to 24 months, others report a drop-off in symptom improvement at 12-18 months. Patient satisfaction ranged from 52% to 90% and deteriorated with increasing time post-procedure in one study. The findings in this review must be validated in robust randomised sham-controlled trials of adequate power. There remain a number of unanswered questions in terms of which laser medium to use, optimal device settings, ideal interval between treatments, pre-treatment vaginal preparation, as well as safety and efficacy of repeated treatments long term. These issues could be addressed most efficiently with a mandatory registry of vaginal laser procedures.

Background: Menstruation is a natural process that occurs monthly in women. Although menstruation is a fundamental aspect of women's lives, their readiness for and beliefs about menstruation vary. Moreover, their practices during menstruation can be influenced by various factors, including age, education level, mother's education, and field of specialty. This study aimed to explore menstruation-related readiness, beliefs, and practices among women who had experienced menstruation in Saudi Arabia. In addition, the study aimed to evaluate the factors affecting these women's readiness, beliefs, and practices regarding menstruation.

Patients and methods: This cross-sectional online questionnaire-based study included 3471 women of different ages who had experienced menstruation. The participants were selected using convenience sampling from all regions of Saudi Arabia. The questionnaire was distributed between late December 2022 and March 2023 and included questions on demographics and menstruation-related readiness, beliefs, and practices.

Results: Of the 3471 participants, 1627 (46.8%) were well prepared for menstruation. In addition, most of the study participants (80.2%) had positive beliefs about menstruation. However, the participants' menstrual practices varied. Over half of the participants (63%) used painkillers and approximately half (54.4%) used herbal medicine during menstruation.

Conclusion: This study found that less than half of the participants were ready for menarche. In contrast, most participants displayed positive beliefs concerning menstruation. In terms of practices, the women exhibited certain dietary restrictions during their menstrual period and predominantly favored herbal remedies for pain relief over conventional painkillers. Implementing awareness campaigns and incorporating school education on menstrual readiness and hygiene is needed.

Background: The causal relationship of breast cancer (BC) with cardiovascular disease (CVD) and the underlying mediating pathways remains elusive. Our study endeavors to investigate the causal association between BC and CVD, with a focus on identifying potential metabolic mediators and elucidating their mediation effects in this causality.

Methods: In this study, we conducted two-sample Mendelian randomization (MR) to estimate the causal effect of BC (overall BC, ER+ BC, ER- BC) from the Breast Cancer Association Consortium (BCAC) on CVD including coronary heart disease (CHD), hypertensive heart disease (HHD), ischaemic heart disease (IHD), and heart failure (HF) from the FinnGen consortium. Then, we used two-step MR to evaluate 18 metabolic mediators of the association and calculate the mediated proportions.

Results: Genetically predicted ER+ BC was causally associated with an increased risk of CVD including CHD (OR = 1.034, 95% CI: 1.004-1.065, p = 0.026), HHD (OR = 1.061, 95% CI: 1.002-1.124, p = 0.041), IHD (OR = 1.034, 95% CI: 1.007-1.062, p=0.013), and HF (OR = 1.055, 95% CI: 1.013-1.099, p = 0.010), while no causality was observed for overall BC and ER- BC. Furthermore, high-density lipoprotein cholesterol (HDL-C) was identified as a mediator of the association between ER+BC and CVD, including CHD (with 15.2% proportion)) and IHD (with 15.5% proportion), respectively.

Conclusion: This study elucidates the potential causal impact of ER+ BC on subsequent risk of CVD, including CHD, HHD, IHD, and HF. We also outline the metabolic mediator HDL-C as a priority target for preventive measures to reduce excessive risk of CVD among patients diagnosed with ER+BC.

Background: Intrauterine devices (IUDs) are among the most popular contraceptive methods globally due to their convenience and cost-effectiveness. However, improper placement can lead to complications such as device migration and uterine perforation, with increased risk observed when IUDs are implanted within four to six weeks postpartum. Typically, patients are asymptomatic or experience mild lower abdominal discomfort or minor abnormal vaginal bleeding following IUD displacement. Advances in diagnostic techniques have resulted in an increased reporting of uterine perforations due to IUD migration. Although rare, secondary stone formation following IUD perforation has been noted. In 2023, cases of IUD perforation were reported in women with a history of multiple cesarean sections and in a young woman without detailed marital history.

Prior presentation: The 43-year-old patient, who had an IUD inserted three years prior, exhibited symptoms of frequent urination and painful urination unrelieved by anti-infective and analgesic treatments. The patient underwent cystotomy for foreign body removal, which revealed the IUD had perforated the uterus and bladder, with both arms of the device invaded into bladder wall and covered with concentric stone layers. Complete removal of the IUD and surrounding stones, followed by suturing and postoperative anti-infection analgesic treatment, led to significant symptom improvement.

Conclusion: This case underscores the importance of regular IUD check-ups to prevent uterine perforation and the necessity of considering IUD migration in patients presenting with lower urinary tract symptoms without routine IUD examination. While self-examination by the patient through the strings in the vagina is possible, imaging studies are also indispensable. Surgery has proven to be an effective solution for such complications, but cystoscopy is not always the best option, and the decision to perform open surgery should be based on the patient's perforation and the condition of the surrounding tissues. This paper emphasizes the need for vigilance and proper clinical management.

Purpose: To describe the magnitude and trend of the iatrogenic genitourinary fistula in Uganda, and the risk factors for development following the Cesarean Section (CS).

Methods: A retrospective review of charts of women with a confirmed diagnosis of genitourinary fistula at four regional fistula repair sites in Uganda between 2010 and 2021 was conducted. A fistula was classified as iatrogenic if it was; ureteric, vesico-cervical, vesico-uterine, or vaginal vault fistula that followed an obstetric or gynecological surgery. The annual proportions for the ischemic and iatrogenic fistula over the study period were compared. A sub group analysis of women with genitourinary fistula delivered by CS was done to determine the factors associated with iatrogenic fistula. Multivariable log binomial regression was performed to determine the independent risk factors.

Results: There were 521 women who presented with genito-urinary fistula of which, 169 (32.4%) were iatrogenic. Most of the iatrogenic fistulae followed CS (71%). The proportions of iatrogenic fistulae increased from 8/52 (9.6%) in 2010 to 38/88 (43.2%) in 2020. The risk factors for iatrogenic fistula following CS were; Grand-multiparity (OR = 5.8; 95% CI: 2.1-15.4), Repeat CS (OR = 4.1; 95% CI: 1.8-9.3), CS performed by an intern doctor (OR = 4.8; 95% CI: 1.5-15.5) and CS done at a Health Centre IV (OR = 4.5; 95% CI: 1.2-16.7).

Conclusion: The magnitude of the iatrogenic genitourinary fistula in Uganda is high and most follow CS. There is an observed rising trend in iatrogenic fistula. The risk factors for iatrogenic fistula following CS are grandmultiparity, repeat CS, CS performed by intern doctors and CS performed at lower health facilities. There is a need for continuous training and supervision of lower cadre doctors involved in CS to reduce on the rising trend of iatrogenic fistula.

Purpose: To evaluate the association between Composite Dietary Antioxidant Index (CDAI) and the risk of endometriosis in American women.

Methods: The study adopted a cross-sectional design, incorporating 3862 women aged over 20 years, selected from the National Health and Nutrition Examination Survey (NHANES) dataset from 2001 to 2006. Six dietary antioxidants were taken into account in calculating CDAI. Endometriosis was determined based on self-report. To evaluate the association between CDAI and the risk of endometriosis, we employed models with multivariable logistic variables. For subgroup assessment in relation to CDAI, a stratified multivariate logistic regression model was utilized.

Results: Among all participants, 273 participants (7.1%) were found to exhibit endometriosis. The preliminary analysis showed a reverse association between CDAI and the likelihood of endometriosis (odds ratio [OR] = 0.95; 95% confidence interval [CI]: 0.92~0.98). Upon full adjustment within the multivariable logistic regression, the ORs (95% CI) for endometriosis prevalence per unit increase in CDAI were estimated to be 0.96 (0.93~1). When the CDAI levels were divided into quartiles, it was found that the ORs for endometriosis with CDAI levels in Q2 (-2.131-0.023), Q3 (0.023-2.650), and Q4 (2.650-42.854) were 0.74 (0.52, 1.05), 0.76 (0.53, 1.1), and 0.53 (0.36, 0.79), respectively, compared to those with CDAI levels in Q1 (-7.151--2.131). We evaluated the association between CDAI and endometriosis using subgroups stratified by age, race/ethnicity, education level, body mass index (BMI), oral contraceptive, and menopausal status, revealing a substantial negative relationship.

Conclusion: In this cross-sectional study, increasing CDAI was proportionally associated with a reduced risk of endometriosis among American women, suggesting a diet high in antioxidants may play an important role in reducing the risk of endometriosis. The findings of NHANES data spanning 2001 to 2006 suggest that promoting antioxidant-rich diets could be an important prevention strategy for endometriosis.

Background: Retroperitoneal ectopic pregnancy (REP) is a rare form of ectopic pregnancy, in which fertilised eggs are implanted in the retroperitoneal cavity. Due to its atypical location and non-specific symptoms, REP is often misdiagnosed, leading to delayed treatment. This condition poses serious risks owing to its proximity to the retroperitoneal blood vessels. Limited research and lack of specific guidelines make the management of REP challenging.

Case report and literature review: A 47-year-old woman with REP was initially misdiagnosed as having acute gastroenteritis due to severe abdominal pain and gastrointestinal symptoms. She had amenorrhoea and significant lower abdominal pain, but no vaginal bleeding. After 35 days of amenorrhoea, the patient's serum beta-human chorionic gonadotropin (β-hCG) level was 16111.94 mIU/mL. Imaging revealed no intrauterine gestational sac; however, a mass was detected in the left adnexal area. Emergency laparoscopy identified a 3.0 cm ectopic mass in the retroperitoneal space, adjacent to the lower edge of the left broad ligament and near critical structures, with surface rupture and bleeding. The mass was surgically removed, and the patient's β-hCG levels returned to normal 33 days post-surgery. In addition, we reviewed previously published English literature on REP, highlighting its characteristics, pathogenesis, diagnosis, and treatment with the aim of improving the understanding and management of the condition.

Conclusion: REP is difficult to diagnose because of its rarity and nonspecific symptoms. Early diagnosis relies on serum β-hCG testing, ultrasonography, and radiological examination. When β-hCG is elevated and no gestational sac is found within the uterus or at common ectopic sites, REP should be considered. Surgical resection is the primary treatment for this condition.

Background: The prevalence of intimate partner violence (IPV) is higher among women with lower social and economic status. Moreover, empowerment-focused interventions might not protect them from domestic abuse. This study assessed Saudi women's empowerment and its usefulness as a stand-alone IPV predictor.

Methods: 400 married women, ages 19 to 65, who visited the outpatient clinics of PHC centers in Riyadh were interviewed using the Women's Empowerment module and the previously Arabic-validated version of the WHO multi-country instrument on Violence Against Women (VAW) to learn more about the beliefs of women regarding IPV and women's empowerment (in the decision-making process and the freedom to move). Logistic regression analysis was employed to identify the IPV predictors. At p<0.05, significance was established.

Results: In terms of physical (18.5%), emotional (25.5%), sexual (19.2%), and economic (25.3%) violence, the lifetime overall IPV prevalence was 44.8%. 19.5% of all women said they had a negative attitude towards IPV. From 41.8% of women who reported a positive attitude towards violence to 45% and 56.8% among those who reported neutral and negative attitudes, respectively, the prevalence of IPV rose significantly (χ2_LT = 4.35, p = 0.037). Roughly one-third of women had no authority to make decisions (33%) or the freedom to move about (40.1%). When comparing empowered to non-empowered women, it was found that IPV was significantly less common in the decision-making process (30.1% versus 77%, χ2=74.91, p<0.001) and in the freedom to move (16.2% versus 27.7%, χ2=5.77, p=0.016). After adjusting for relevant confounders, women's empowerment was an independent predictor of IPV (OR=0.734, 95% CI: 0.63-0.85).

Conclusion: Women's empowerment is a strong predictor of IPV. Women who lack social and economic authority should receive assistance from the government. Advocacy initiatives that emphasize transforming cultural perceptions of violence and enabling women to participate in decision-making processes should be supported.

Objective: To evaluate the therapeutic outcomes of weight loss and metformin use in patients with endometrial hyperplasia (EH), and to identify the factors influencing treatment efficacy.

Methods: This study included data from patients diagnosed with either EH or endometrial atypical hyperplasia (EAH). Patients selected a progestin treatment regimen based on their diagnosis. Those with concurrent obesity or insulin resistance received additional weight management support and metformin therapy. Follow-up assessments were conducted every 3-6 months.

Results: A total of 202 patients were included. The metformin group exhibited significantly greater improvement in abnormal uterine bleeding (91.5% vs 57.1%, p < 0.001) and in ultrasound findings (91.5% vs 66.7%, p < 0.001) than the non-metformin group. Patients who achieved >3% weight loss and those using metformin showed a significantly higher rate of disease reversal than those with ≤3% weight loss (91.2% vs 77.6%, p = 0.034) and the non-metformin group (93.2% vs 52.4%, p < 0.001). At follow-up durations exceeding 12 months, metformin use was associated with a significantly higher disease reversal rate (82.1% vs 42.9%, p = 0.048) and a lower recurrence rate (12.8% vs 28.6%, p = 0.048). Weight loss of >3% (odds ratio: 0.041, 95% confidence interval: 0.004-0.437, p = 0.008) and metformin use (odds ratio: 0.059, 95% confidence interval: 0.011-0.311, p = 0.001) were both independently associated with improved reversal rates in patients with EH/EAH.

Conclusion: Combining progestin therapy with weight loss and metformin is more effective in reversing EH than progestin alone. Regular metformin use, alongside weight loss, serves as a protective factor in EH management, with the protective effect of metformin increasing with longer use.

Purpose: Few factors have been identified that increase the risk of visits (hospital emergency room or inpatient stays) due to hyperemesis gravidarum (HG). The purpose of this study is to understand trends in HG management and identify variables increasing visit frequency so that strategies may be developed to reduce hospital utilization.

Study design: An online survey was posted on the Hyperemesis Education and Research Foundation website and social media between June 2022 and May 2023. Participants had previous or current severe pregnancy nausea and vomiting. Respondents were asked about themselves and their HG experience, including weight loss, medications, infusion care, and visit frequency. Odds ratios, p-values, and 95% confidence intervals were calculated via MedCalc to analyze the significance of each factor, and Spearman rank correlations were analyzed via SPSS for associations of ondansetron usage with visits and weight loss. Microsoft Excel and SPSS were used to calculate treatment and visit frequencies.

Results: Survey data from 1220 respondents who reported a current or prior pregnancy with HG were included in this study. Respondents were primarily White, from the US, and had at least one visit due to HG. Participants with a visit were significantly more likely to be a person of color (POC), unable to work, have no children, and lose over 15 pounds (6.8 kg). Those who took medications as prescribed had fewer visits. No medication combination or dose was found to be significantly more effective in preventing weight loss or repeat hospital visits.

Conclusion: Risk factors predicting visits included POC, not having children, being too sick to work, and having extreme weight loss. Utilization of medication and nutritional therapies is inconsistent and inadequate in this population, which may increase visit frequency.